Patients with discordant responses to antiretroviral therapy have impaired killing of HIV-infected T cells

PLoS Pathog. 2010 Nov 24;6(11):e1001213. doi: 10.1371/journal.ppat.1001213.


In medicine, understanding the pathophysiologic basis of exceptional circumstances has led to an enhanced understanding of biology. We have studied the circumstance of HIV-infected patients in whom antiretroviral therapy results in immunologic benefit, despite virologic failure. In such patients, two protease mutations, I54V and V82A, occur more frequently. Expressing HIV protease containing these mutations resulted in less cell death, caspase activation, and nuclear fragmentation than wild type (WT) HIV protease or HIV protease containing other mutations. The impaired induction of cell death was also associated with impaired cleavage of procaspase 8, a requisite event for HIV protease mediated cell death. Primary CD4 T cells expressing I54V or V82A protease underwent less cell death than with WT or other mutant proteases. Human T cells infected with HIV containing these mutations underwent less cell death and less Casp8p41 production than WT or HIV containing other protease mutations, despite similar degrees of viral replication. The reductions in cell death occurred both within infected cells, as well as in uninfected bystander cells. These data indicate that single point mutations within HIV protease which are selected in vivo can significantly impact the ability of HIV to kill CD4 T cells, while not impacting viral replication. Therefore, HIV protease regulates both HIV replication as well as HIV induced T cell depletion, the hallmark of HIV pathogenesis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Antiretroviral Therapy, Highly Active*
  • Blotting, Western
  • Caspase 8 / genetics
  • Cells, Cultured
  • Drug Resistance, Viral / genetics*
  • Female
  • Flow Cytometry
  • HIV Infections / drug therapy
  • HIV Infections / etiology
  • HIV Infections / pathology*
  • HIV Protease / genetics*
  • HIV Protease / metabolism*
  • HIV Protease Inhibitors / therapeutic use
  • HIV Seropositivity / genetics
  • HIV-1 / physiology*
  • Humans
  • Male
  • Membrane Potential, Mitochondrial
  • Middle Aged
  • Mutagenesis, Site-Directed
  • Mutation / drug effects
  • RNA, Messenger / genetics
  • Reverse Transcriptase Polymerase Chain Reaction
  • T-Lymphocytes / metabolism
  • T-Lymphocytes / pathology*
  • T-Lymphocytes / virology
  • Virus Replication / drug effects
  • Virus Replication / genetics
  • Young Adult


  • HIV Protease Inhibitors
  • RNA, Messenger
  • Caspase 8
  • HIV Protease